血浆氧化低密度脂蛋白测定的临床价值

目的 :观察脂代谢紊乱相关疾病患者血浆氧化低密度脂蛋白 (ox LDL)水平的变化规律 ,探讨血ox LDL测定的临床意义。方法 :素食 1d后禁食 12h采静脉血 ,用双抗体夹心ELISA法测定血浆ox LDL的水平。观察对象 30 2例 ,其中原发性高血压 (EH) 6 2例 ,EH并发冠心病 (CHD) 5 5例 ,糖尿病 (DM) 38例 ,DM并发CHD 4 9例 ,CHD 4 4例 ,肾病综合征 5 4例。正常对照者 111例。结果 :EH、DM、CHD、肾病综合征患者血ox LDL测定值均高于正常对照者 (P <0 .0 5 )。EH心室肥厚者ox LDL值明显高于非心室肥厚者 (P <0 .0 5 ) ;而并发CHD者明显高于未并发CHD者 (P <0 .0 5 )。DM并发CHD者明显高于未并发CHD者 (P <0 .0 5 ) ;但未并发CHD者血ox LDL仍高于正常对照者 ,差异有显著性意义 (P <0 .0 5 )。CHD中不稳定型心绞痛者明显高于稳定型心绞痛者 (P <0 .0 5 ) ;稳定型心绞痛者血ox LDL测定值与正常对照者差异无显著性意义 (P >0 .0 5 ) ;但冠状动脉 (冠脉 )显著狭窄者明显高于冠脉无显著狭窄者 (P <0 .0 5 ) ;冠脉无显著狭窄者血ox LDL测定值与正常对照者差异无显著性意义 (P >0 .0 5 )。结论 :EH及DM患者血ox LDL水平高于正常人 ,并发CHD后血ox LDL水平更高 ;CHD中不稳定型心绞痛患者血ox LDL水平高于正常人 ,ox LDL水平与冠     

血浆降钙素原测定在肝硬化伴自发性细菌性腹膜炎患者中的临床应用

目的　探讨血浆降钙素原 (procalcitonin ,PCT)对肝硬化伴自发性细菌性腹膜炎 (spontaneousbacterialperitonitis ,SBP)的诊断价值及与临床病程和预后的关系。方法　采用金标层析法测定 112例肝硬化腹水患者 (单纯腹水 5 1例 ,合并SBP 6 1例 )血浆PCT水平。结果　肝硬化腹水患者血浆PCT水平均显著高于正常 ,以 10ng/mL为阳性判断值时 ,SBP组阳性检出率显著高于无SBP组(P <0 0 0 1) ,且与培养是否阳性无关。最初三天血浆PCT水平变化与临床结局密切相关。结论　血浆PCT测定对肝硬化伴SBP的早期快速诊断及预后判断等有重要价值。     

CA125检测在活动性结核判定及疗效评估中的价值

目的　探讨血清CA12 5测定在活动性肺结核判定及疗效评估中的价值。方法　应用化学发光法分别对3 0例活动性肺结核治疗前、治疗后 2个月、4个月、6个月以及 3 0例非活动性肺结核和 3 0例健康体检者血清CA12 5进行测定。并对结果进行分析。结果　活动性肺结核治疗前血清CA12 5水平显著高于非活动性肺结核及健康体检者 (P <0 0 1)。活动性肺结核治疗前CA12 5水平显著高于治疗后各期测定值 (P <0 0 1) ,且治疗后血清CA12 5水平呈递减趋势。活动性肺结核治疗后 6个月血清CA12 5水平与非活动性肺结核比较无明显差异 ( P >0 0 5 )。结论　血清CA12 5测定可作为判定活动性肺结核及评估疗效的可靠指标     

内源性神经肽与肝硬化腹水的形成

目的:探讨肝硬化患者血浆亮啡肽(LENK)、神经肽Y(NPY)的变化规律及其在腹水形成中的意义。方法:用放射免疫法检测19例有腹水、18例无腹水的肝硬化患者血浆LENK、NPY含量,并以18例慢性肝炎,14例急性肝炎和10名健康者为对照。结果:肝硬化患者血浆LENK含量显著高于正常人和急、慢性肝炎(P <0.01),有腹水者显著高于无腹水者(P<0、01),而血浆NPY水平肝硬化患者明显下降(P<0.01),有腹水者下降更明显(P<0.01)。结论:肝硬化患者血浆LENK、NPY等内源性神经肽水平明显变化,且以有腹水者为甚,提示这种神经肽可能参与了肝硬化患者的高动力状态循环异常,并与腹水形成有关。     

肝硬化伴自发性细菌性腹膜炎患者血浆降钙素原与预后的关系

目的　探讨血浆降钙素原 (procalcitonin ,PCT)与肝硬化伴自发性细菌性腹膜炎 (spontaneousbacterialperitonitis,SBP)患者预后的关系。方法　采用免疫发光法检测 10 2例肝硬化腹水 (54例SBP、18例腹部脓毒症和 3 0例单纯腹水 )血浆PCT水平。结果　肝硬化伴SBP组血浆PCT水平显著高于单纯腹水组 ,腹部脓毒症组显著高于SBP组 (均P <0 0 0 1)。死亡组 (SBP和腹部脓毒症病人 )入院时血浆PCT水平与同期存活组相比 ,差异有显著性意义 (P <0 0 5)。最初 3天血浆PCT水平变化与SBP临床不同结局密切相关 ,但对腹部脓毒症预后判断价值有限。结论　血浆PCT检测对肝硬化伴SBP患者预后判断和腹部脓毒症的早期诊断具有重要价值     

老年慢性心力衰竭患者心功能与神经内分泌系统变化的特点

目的　探讨老年慢性心力衰竭患者心功能状态及神经内分泌系统变化的特点。方法　将入院诊断为慢性心力衰竭急性发作的患者 16 4例分为老年组 (10 0例 )和非老年组 (6 4例 )。根据症状对患者进行心功能分级 (NYHA) ;根据血流动力学指标对患者进行Forrester分级。用放射免疫法测定血浆去甲肾上腺素 (NE)、肾素活性 (PRA)、血管紧张素Ⅱ (AngⅡ )、醛固酮 (ALD)及心房肽 (ANP)和脑钠素 (BNP)浓度。结果　 (1)老年组由缺血性心脏病所致心力衰竭的比例显著高于非老年组 (P <0 .0 5 ) ;(2 )老年组NYHAⅣ级以及ForresterⅣ级的比例较非老年组多 (P <0 .0 1,P <0 .0 5 ) ;(3)老年组心脏指数及左心室射血分数均较非老年组显著降低 (P <0 .0 1,P <0 .0 1) ;(4 )两组患者的神经内分泌因子较正常对照组显著增加 ,老年组除PRA外 ,NE、AngⅡ、ALD、ANP和BNP血浆浓度的增加较非老年组显著为低 (分别为 P <0 .0 5 ,P<0 .0 1,P <0 .0 5 ,P<0 .0 1,P<0 .0 5 )。结论　老年慢性心力衰竭由缺血性心脏病引起者较多 ,急性发作时其临床症状较重 ,心功能低下较为显著 ,但神经内分泌系统的反应性不明显     

系统性红斑狼疮患者血浆-11-去氢血栓烷B_2测定及其临床意义

目的　观察系统性红斑狼疮 (SLE)患者体内血小板活化状态。方法　采用酶联免疫吸附法 (ELISA)检测 32例SLE患者血浆 11 去氢 血栓烷B2 (DH TXB2 ) ,同时测定TXB2 ,并与对照组比较。结果　与对照组比较 ,SLE患者血浆DH TXB2 、TXB2 均显著增高 (P <0 0 1及P <0 0 5 ) ,且DH TXB2 增高程度明显高于TXB2 ,与对照组无重叠 ,肾受累者显著高于无肾脏受累者 (P <0 0 5 ) ,经治疗者显著低于初发未治疗者 (P <0 0 1) ,但仍高于对照组 (P <0 0 5 )。血浆TXB2 与DH TXB2 浓度与疾病活动指数均呈正相关 (r1=0 478,P <0 0 5及r2 =0 5 30 ,P <0 0 1)。结论　血浆DH TXB2 水平测定是准确反映血小板活化的指标 ,SLE患者体内血小板高度活化     

急性冠脉综合征早期辛伐他汀治疗对血脂和炎症反应标记物的影响

目的　观察急性冠脉综合征 (ACS)早期辛伐他汀治疗对血脂和炎症反应标记物的影响及差异 ,探讨他汀类药物在ACS早期治疗中的作用。　方法　ACS住院患者 12 3例 ,入院后测定血浆甘油三酯 (TG)、总胆固醇(TC)、低密度脂蛋白胆固醇 (LDL C)、高密度脂蛋白胆固醇 (HDL C)、白细胞介素 6 (IL 6 )和C反应蛋白 (CRP)水平 ,然后随机分为辛伐他汀治疗组和非辛伐他汀治疗组。出院时重复测定上述指标。同期测定 15例慢性稳定性心绞痛 (CAP)患者和 15名健康者作对照比较。　结果　 1 ACS患者血浆TC、LDL C、IL 6、CRP显著高于健康者 (P <0 0 1) ,血浆LDL C、IL 6显著高于CAP患者 (P <0 0 1)。 2 出院与入院时比较 ,辛伐他汀组和非辛伐他汀组血浆IL 6、CRP显著降低 (P <0 0 1) ,出院时辛伐他汀组血浆IL 6、CRP也显著低于非辛伐他汀组 (P <0 0 1)。 3 据入院时血浆IL 6、CRP水平 ,把ACS患者分别分为IL 6、CRP高值组和低值组 ,出院与入院时比较 ,高值组和低值组血浆IL 6、CRP均显著降低 (P<0 0 1,P<0 0 1) ,但只有高值组 ,出院时辛伐他汀治疗者血浆IL 6、CRP显著低于非辛伐他汀治疗者 (P <0 0 1,P <0 0 5 )。　结论　ACS患者早期辛伐他汀治疗有明显抗炎症作用。     

原发性高血压患者静息心率增加的临床意义

目的　探讨静息心率在高血压动脉硬化中的变化及其临床意义。方法　 2 93例高血压患者 ,平均年龄 5 9.2岁 ,男 15 6例 ,女性 137例 ,测定其静息心率、血糖、血脂及进行冠脉造影 ,并进行分组研究。结果　高血压组静息心率77.98± 10 12bpm显著高于正常对照组 72 12± 11 2 5bpm(P <0 0 5 ) ,高血压合并左室肥厚者高于无左室肥厚组 (P<0 0 5 )。高血压合并高血糖者高于血糖正常者 (P <0 0 5 ) ,高血压合并冠脉病变者 ,尤其是合并左前降支狭窄者RHR显著增高 (P <0 0 5 )。结论　静息心率与高血压病及动脉硬化的发展 ,高血压靶器官损害及高血压合并代谢异常有关。     

CA125和肿瘤坏死因子α的血清浓度与慢性充血性心力衰竭相关性的临床研究

目的　探讨慢性充血性心力衰竭 (CHF)患者血清中CA12 5和肿瘤坏死因子α(TNFα)的浓度与心功能和心脏扩大的关系。方法　 10 2例心力衰竭患者根据纽约心脏病学会心功能分级标准分为心功能Ⅱ～Ⅳ级组 ,根据超声心动图检查结果分为左室常大组 (左室舒张末期容积≤ 5 5mm)和左室扩大组 (左室舒张末期容积 >5 5mm)。用酶联免疫吸附测定法测定CA12 5和TNFα的血清浓度。并选 2 0名正常人作为对照。结果　CHF患者CA12 5和TNFα的浓度明显高于正常对照组 (P<0 .0 5 ～ 0 .0 1) ,心功能Ⅲ、Ⅳ级的血清浓度高于Ⅱ级 (P <0 .0 1)。左室扩大组较左室常大组CA12 5和TNFα的血清浓度显著升高 (P <0 .0 1) ,CA12 5和TNFα的血清浓度与心力衰竭患者的心脏扩大呈正相关 (r=0 .6 2 1及 0 .5 4,P <0 .0 5 )。结论　CHF患者血清中CA12 5和TNFα的血清浓度升高 ,升高水平与CHF患者心脏扩大呈正相关。     

Cancer antigen 125: a sensitive marker of ascites in patients with liver cirrhosis

OBJECTIVE: Cancer antigen 125 (CA 125) is a high molecular mass glycoprotein, usually used for monitoring the course of epithelial ovarian cancer. Recently it has been shown that liver cirrhosis is associated with increased levels of CA 125, particularly in the presence of ascites. The aim of this study was to evaluate CA 125 as a marker for the detection of ascites in patients with chronic liver disease. METHODS: A total of 170 patients were studied. All had ultrasound scanning for detection of ascites. Group I consisted of 123 patients with chronic liver disease without ascites; whereas group II consisted of 47 patients with chronic liver disease with ascites. CA 125 levels were measured in all patients and also simultaneously in the ascitic fluid of 31 patients from group II. RESULTS: Of 47 patients, 46 (97.8%) of group II had elevated serum levels of CA 125 (mean 321 +/- 283 U/ml) as compared with only nine of 123 (7.3%) patients of group I [mean 13 +/- 15 U/ml]), p < 0.001. The mean CA 125 concentration in the ascitic fluid of 31 cirrhotic patients (group II) was 624 +/- 397 U/ml and was always higher than corresponding serum levels (p < 0.01). Serum CA 125 levels correlated with the amount of ascitic fluid (r = 0.78). A profound decrease in serum CA 125 concentration was noted 2-3 and 10 days after large volume paracentesis. CA 125 was more sensitive and preceded ultrasonography in detection of ascites in few cirrhotic patients. CONCLUSIONS: CA 125 is a highly sensitive marker to detect ascites in patients with liver cirrhosis. This marker may be useful to detect small to moderate amounts of ascitic fluid in cirrhotic patients when physical examination is difficult or equivocal for ascites.     

Elevation of serum and ascites cancer antigen 125 levels in patients with liver cirrhosis

BACKGROUND AND AIM: Serum cancer antigen (CA) 125 elevation has been reported in patients with liver disease, but it is poorly characterized. The present study aimed to evaluate the range of serum and ascitic CA 125 levels in patients with liver cirrhosis and to explore possible factors associated with CA 125 elevation. METHODS: A total of 70 patients were studied. Group I consisted of 30 patients with liver cirrhosis with or without ascites. Group II consisted of 30 patients with digestive malignant tumors with or without ascites. Group III consisted of 10 patients with benign ascites. The CA 125 levels were measured in the serum of all patients and also simultaneously in the ascitic fluid of 15 patients. RESULTS: Serum CA125 levels in 80% of (24/30) patients from group I were elevated, particularly in those with ascites, irrespective of the etiology of cirrhosis. Serum CA 125 levels were correlated with Child-Pugh scores (r = 0.38), but not significantly (P = 0.06). All patients from group II with ascites and from group III had elevated serum CA 125 levels, but there was no difference in the serum CA 125 levels between patients with ascites from group I (275 +/- 175 U/mL), group II (368 +/- 190 U/mL) or group III (396 +/- 287 U/mL), nor was there a significant difference in ascitic CA 125 levels (P > 0.05). The levels of serum CA 125 (198 +/- 108 U/mL) were lower than, but correlated with that of ascites (460 +/- 234 U/mL, r = 0.58, P = 0.026). The elevation of serum CA 125 accompanied by abnormalities of other tumor markers was more common in malignant ascites than in benign ascites (90% compared with 6%, P < 0.05). CONCLUSION: The elevation of serum CA 125 is common in patients with liver cirrhosis. It is related to the presence of ascites, and possibly to the insufficiency of liver function, but not the etiology of cirrhosis and ascites. Serum CA 125 probably comes from ascites. It usually predicts benign disease if the elevation of serum or ascites CA 125 is not accompanied by the abnormalities of other tumor markers.     

腹水超滤浓缩回输腹腔术治疗肝硬化顽固性腹水疗效分析

目的 探讨腹水超滤浓缩回输腹腔术治疗肝硬化顽固性腹水的疗效。方法 将56例肝硬化顽固性腹水患者随机分为2组,均给予保肝、利尿及抗病毒治疗。在此基础上,对治疗组行腹水超滤浓缩回输腹腔术加小剂量人血白蛋白静脉滴注(静滴)(每滤出1000ml腹水,静滴人血白蛋白4g),对对照组行大量放腹水加大剂量人血白蛋白静滴(每抽出1000ml腹水,静滴人血白蛋白8g)。结果 术后第14天,治疗组患者24h尿量、血清ALB水平均高于对照组(P均<0.05),且治疗组总有效率高于对照组(P<0.05)。结论 腹水超滤浓缩回输腹腔术是一种安全有效的治疗肝硬化顽固性腹水的方法。     

Procalcitonin,and cytokines document a dynamic inflammatory state in non-infected cirrhotic patients with ascites

AIM: To quantitate the simultaneous serum and ascitic fluid levels of procalcitonin and inflammatory markers in cirrhotics with and without ascites.METHODS: A total of 88 consecutive severe cirrhotic patients seen in a large city hospital liver clinic were studied and divided into two groups, those with and without ascites. Group 1 consisted of 41 cirrhotic patients with massive ascites, as demonstrated by necessity for therapeutic large-volume paracentesis. Group 2 consisted of 47 cirrhotic patients without any clinically documented ascites to include either a recent abdominal computed tomography scan or ultrasound study. Serum and ascitic fluid levels of an array of inflammatory markers, including procalcitonin, were measured and compared to each other and a normal plasma panel (NPP).RESULTS: The values for inflammatory markers assayed in the serum of Groups 1 and 2, and ascitic fluid of the Group 1. The plasma levels of the inflammatory cytokines interleukin (IL)-2, IL-4, IL-6, IL-8, interferon gamma (IFNγ) and epidermal growth factor (EGF) were all significantly greater in the serum of Group 1 as compared to that of the serum obtained from the Group 2 subjects (all P < 0.05). There were significantly greater serum levels of IL-6, IL-8, IL-10, monocyte chemoattractant protein-1, tumor necrosis factor-α, vascular endothelial growth factor and EGF when comparing Group 2 to the NPP. There was no significant difference for IL-1A, IL-1B, IL-2, IL-4 and IFNγ levels between these two groups. Serum procalcitonin levels were increased in cirrhotics with ascites compared to cirrhotics without ascites, but serum levels were similar to ascites levels within the ascites group. Furthermore, many of these cytokines, but not procalcitonin, demonstrate an ascites-to-serum gradient. Serum procalcitonin does not demonstrate any significant difference segregated by liver etiology in the ascites group; but ascitic fluid procalcitonin is elevated significantly in cardiac cirrhosis/miscellaneous subgroup compared to the hepatitis C virus and alcoholic cirrhosis subgroups.CONCLUSION: Procalcitonin in the ascitic fluid, but not in the serum, differentiates between cirrhotic subgroup reflecting the dynamic interplay of ascites, bacterial translocation and the peri-peritoneal cytokine.     

Atrial natriuretic factor in cirrhotic patients with tense ascites. Effect of large-volume paracentesis

The plasma levels of atrial natriuretic factor in liver cirrhosis can be affected by various factors, such as ascites, renal function, use of diuretics drugs and dietary sodium intake. Moreover, the influence of high intra-abdominal pressure on cardiac atrial natriuretic factor release in patients with tense ascites has not been investigated. The aim of the present study was to evaluate the circulating levels of atrial natriuretic factor and their relationships to plasma renin activity, aldosterone concentration, and urinary sodium excretion in 45 cirrhotic patients divided into 4 groups: (a) cirrhotics without ascites; (b) nonazotemic cirrhotics with ascites; (c) cirrhotics with ascites and functional renal failure; and (d) cirrhotics with ascites taking diuretics. In some patients with tense ascites, atrial natriuretic factor was also measured after rapid abdominal relaxation by large volume paracentesis. Plasma levels of atrial natriuretic factor obtained in 13 healthy control subjects after 5 days on a 40-50 mEq sodium daily intake were 22.8 +/- 3.3 pg/ml. Mean plasma atrial natriuretic factor levels were normal in patients without ascites (35.1 +/- 11.4 pg/ml) and in those with ascites taking diuretics (27 +/- 9.2 pg/ml), but elevated in patients with ascites not taking diuretics (59.6 +/- 12 pg/ml) and in those with ascites and functional renal failure (58.5 +/- 16.6 pg/ml). These data show that plasma atrial natriuretic factor levels are elevated only in cirrhotic patients who are ascitic and not taking diuretics. In these patients atrial natriuretic factor levels were directly correlated with urinary sodium excretion, even though sodium balance was positive. This could be the consequence of the contrasting effects of antinatriuretic factors, as suggested by the inverse relationships between atrial natriuretic factor and urinary sodium on the one hand and plasma renin activity and plasma aldosterone concentration on the other. Twenty-six patients with tense ascites (12 taking diuretics and 14 not) were treated with rapid large-volume paracentesis (6500 +/- 330 ml of ascitic fluid removed in 168 +/- 16 min). At the end of the procedure, plasma atrial natriuretic factor levels had increased in all patients (from 45.5 +/- 10.1 to 100 +/- 17 pg/ml), whereas plasma renin activity and plasma aldosterone concentration had decreased (from 10.3 +/- 1.6 to 7 +/- 1.3 ng/ml/h, and 1160 +/- 197 to 781 +/- 155 pg/ml, respectively).(ABSTRACT TRUNCATED AT 400 WORDS)     

Prospective Evaluation of a Peritoneal Dialysis Catheter System for Large Volume Paracentesis

Large volume paracentesis is becoming a popular form of therapy for patients with massive ascites and cirrhosis. Although the physiologic effects of the removal of large amounts of ascitic fluid have been well described, the techniques utilized to perform the procedure are either not well documented or not currently available. Over a 13-month period, 52 patients with moderate to severe ascites have undergone 73 large volume paracenteses with a peritoneal dialysis catheter system. The mean volume of ascitic fluid removed was 7.6 L, with a mean time of removal of 129 min. Total paracentesis was accomplished within 1 h in 38% of procedures. The most common site for paracentesis was the left lower quadrant. Complications related to the procedure were few, the most common being a self-limited ascitic fluid leak at the sight of paracentesis. No patient experienced intestinal perforation, peritonitis, or a significant change in serum creatinine after the procedure. The widely available peritoneal dialysis catheter system represents a safe and rapid technique for the removal of large quantities of ascitic fluid.     

Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis

To assess the risk of development of spontaneous bacterial peritonitis in relation to the ascitic fluid total protein concentration, routine admission abdominal paracentesis was performed on a group of 107 patients during 125 hospitalizations. The paracentesis was repeated if evidence of peritonitis developed during hospitalization. Twenty-one episodes of spontaneous peritonitis (or its culture-negative variant) were documented in 17 patients. The ascitic fluid protein concentration in the spontaneous peritonitis group (0.72 +/- 0.53 g/dl) was significantly lower (p less than 0.001) than that in the group of patients with sterile portal hypertension-related ascites (1.36 +/- 0.89 g/dl) and was significantly lower than that of patients with ascites due to miscellaneous causes. Of the patients whose initial sterile ascitic fluid protein concentration was less than or equal to 1.0 g/dl, 7 of 47 (15%) developed spontaneous peritonitis during their hospitalization; whereas only 1 of 65 (1.5%) patients who had an initial sterile ascitic fluid protein concentration greater than 1.0 g/dl developed spontaneous peritonitis. This difference in risk of development of peritonitis in relation to initial ascitic fluid protein concentration was also significant (p less than 0.01). Low-protein-concentration ascitic fluid predisposes to spontaneous bacterial peritonitis.     

Disease dependent qualitative and quantitative differences in the inflammatory response to ascites occurring in cirrhotics简

AIM: To assess differing patterns and levels of ascitic fluid cyctokine and growth factors exist between those with a high risk and low risk of spontaneous bacterial peritonitis (SBP).METHODS: A total of 57 consecutive patients with ascites requiring a large volume paracentesis were studied. Their age, gender, specific underlying disease conditions were recorded after a review of their clinical records. Each underwent a routine assessment prior to their paracentesis consisting of a complete blood count, complete metabolic profile and prothrombin time/international normalized ratio (INR) determination. The ascitic fluid was cultured and a complete cell count and albumin determination was obtained on the fluid. In addition, blood and ascitic fluid was assessed for the levels of interleukin interleukin (IL)-1A, IL-1B, IL-2, IL-4, IL-8, IL-10, monocyte chemotactic protein (MCP)-1, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, vascular endothelial growth factor (VEGF) and epidermal growth factor (EGF) utilizing the Randox Biochip platforms (Boston, MA). A serum-ascites gradient, for each cytokine and growth factor was calculated. The results are reported as mean ± SEM between disease groups with statistical analysis consisting of the student t-test (two tailed) with a P value of 0.05 defining significance.RESULTS: No clinically important demographic or biochemical differences between the 4 groups studied were evident. In contrast, marked difference in the cytokine and growth factors levels and pattern were evident between the 4 disease groups. Individuals with alcoholic cirrhosis had the highest levels of IL-1A, IL-1B, IL-4, IFNγ. Those with malignant disease had the highest levels of IL-2. Those with hepatitis C virus (HCV) associated cirrhosis had the highest value for IL-6, IL-8, IL-10, MCP-1 and VEGF. Those with cardiac disease had the highest level of TNF-α and EGF. The calculated serum- ascites gradients for the cardiac and malignant disease groups had a greater frequency of negative values signifying greater levels of IL-8, IL-10 and MCP-1 in ascites than did those with alcohol or HCV disease.CONCLUSION: These data document important differences in the cytokine and growth factor levels in plasma, ascitic fluid and the calculated plasma - ascites fluid gradients in cirrhotics requiring a large volume paracentesis. These differences may be important in determining the risk for bacterial peritonitis.     

Diagnosis of malignant versus tuberculous ascites using tumor markers and globulin ratios in serum and ascites: A Fisher discriminant model

Background and study aimsThis study was conducted to investigate the significance of tumor and biochemical markers in serum and ascitic fluid in the differential diagnosis of tuberculous and malignant ascites.Patients and methodsBased on findings from natural orifice transluminal endoscopic surgery and postoperative pathology or cytology of 63 patients, they were divided into the malignant group (31 patients) and the tuberculous group (32 patients). Levels of tumor markers, albumin, globulin, and lactate dehydrogenase were measured simultaneously. Data were statistically analyzed, and a Fisher discriminant model was established. The receiver operating characteristic curve was constructed to confirm the discriminant value.ResultsThe levels of carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), cancer antigen 19-9 (CA 19-9), and globulin in serum and ascitic fluid were different between the tuberculous and malignant ascites groups (P < .05). The ratios of ascites-to-serum levels of CEA, CA125, and CA 19-9, as well as the ratio of serum-to-ascites of globulin levels, were different between the two groups (P < .05). The Fisher discriminant model was established based on the ascites-to-serum ratios of CEA, CA125, and CA 19-9 levels and the serum-to-ascites ratio of globulin levels. The area under the curve was 0.908, the sensitivity was 0.838 (26/31), and the specificity was 0.875 (28/32).ConclusionA Fisher discriminant model can be established using serum and ascites tumor markers and globulin ratios, which is valuable in the differential diagnosis of tuberculous versus malignant ascites.     

Total paracentesis associated with intravenous albumin management of patients with cirrhosis and ascites

Repeated large-volume paracentesis (4-6 L/day) is an effective and safe therapy of ascites in patients with cirrhosis provided albumin is infused intravenously. To investigate whether ascites can be safely mobilized in only one paracentesis session ("total paracentesis"), 38 cirrhotic patients with tense ascites were treated with total paracentesis plus intravenous albumin (6-8 g/L ascites removed). Standard liver tests and renal function tests, glomerular filtration rate, free water clearance, plasma volume, plasma renin activity, and plasma aldosterone and norepinephrine concentrations were measured before and after treatment. Total paracentesis was effective in mobilizing ascites in all but 1 patient and did not impair any of the parameters studied. The volume of ascitic fluid removed and the duration of the procedure were 10.7 +/- 0.5 L (mean +/- SEM) and 60 +/- 3 min, respectively. Five of the 38 patients (13%) developed complications during the first hospital stay (hepatic encephalopathy and gastrointestinal hemorrhage in 2 patients each and culture-negative bacterial peritonitis in 1). No patient developed renal impairment. This complication rate, as well as the clinical course of the disease during follow-up, estimated by the probability of readmission to hospital, causes of readmission, and survival probability after treatment, was similar to that reported in patients treated with repeated large-volume paracentesis. These results indicate that total paracentesis associated with intravenous albumin can be safely performed in cirrhotic patients with tense ascites and suggest that these patients could be treated in a single-day hospitalization regime.